Organization
NEW LEAF BEHAVIORAL HEALTH CLINICIANS, LLC
Active
Parent organization
NEW LEAF BEHAVIORAL HEALTH CLINICIAN
Other names
HESED Medical
Organization subpart
Yes
Provider details
NPI number
Legal business name
NEW LEAF BEHAVIORAL HEALTH CLINICIAN
Authorized official
MR. HORATIO ACQUINALDO MILLIN JR. MD (OWNER/MANAGER)
(337) 476-1338
Entity
Organization
Contact information
Practice address
2905 FISKE STREET, LAKE CHARLES, LA 70601-8550
(337) 476-1338
Mailing address
2905 FISKE STREET, LAKE CHARLES, LA 70601-8550
(337) 476-1338
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1049085
—
LA
Enumeration date
08/07/2020
Last updated
08/07/2020
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